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Together With Love at an Unassisted Birth by Jules Baird (BirthWorks Doula Student)

“She's coming, she's coming, she's coming!" exclaimed the birthing mother.
"Your body and your baby clearly know exactly what they are doing. We are here with
you," I responded as her doula.

My name is Jules. I live down here in Christchurch, New Zealand and have recently
attended my first two births as a Doula in training with Birthworks International. In my
first birth as a doula, I was welcomed and encompassed by the beautiful home birth
midwives and able to support my friend to have an empowering calm home birth.

My second birth was just a month or so later with a mother having her fourth baby and
with a history of fast births. Her second child was a planned home birth with a midwife
after a traumatic hospital first birth. The baby arrived on the bathroom floor before her
midwife arrived. Her mother in law was present and all were well but it was a scary
experience for this mother.

She was able to have a slower calm, attended water-birth with her third in her living
room. Now, her fourth pregnancy was a surprise and caught mother and father off
guard. For them, it took many months to come to terms with having a fourth unplanned
child. I met her late in her pregnancy when she had injured her ankle and was left
mostly immobile. We formed a strong connection over several visits and I noted her
main fears were to be alone during birth and to have an injury due to a fast labor.

The day came. I answered my phone at 2:50am to a very calm positive voice saying,

"I think the baby is coming."
“What’s happening?” I asked.
“I’ve been contracting for half an hour and my water just broke. Yes, come!”

Even though her tone was very calm and relaxed I took her call for me to come very
seriously and got to her house 15mins later (thankfully she lived very close).

Walking in, I heard the mum on the phone saying to her midwife,
"Ok,...I suppose I will call you back when I really, really need you here.”

She sounded slightly dejected. I greeted her husband who was busy in the kitchen
boiling water and beginning to fill the pool. I rounded the corner to greet mum with a
smile as she rolled onto her knees on the couch as a very strong contraction began.

"Wow this is very, very strong...this is the first one like this...maybe I do need to call my
midwife back," she says through some low primal groans.

Her body seemed to shift gear as soon as soon as I, her support person, arrived. I
applied back pressure through this contraction and when it has passed I asked,

“Would you like me to dial your midwife or shall we wait for one more contraction?”
“Wait for another contraction,” she decides.

Moments later, the next contraction came, even stronger than the last one. We move
through this contraction together and then she dials her midwife. As she does I look and
see the pool is a long way from full so I quickly take a hot water bottle, fill it and wrap it
in a clean towel to support her with heat ( a decision that turned into a small miracle
later on, from a carer’s perspective).

The next contraction was stronger again and with a panicked voice and low grunting this
beautiful mother moved to the ground on some clean towels her husband and I lay out
and said,

"She's coming, she's coming, she's coming!"

Mindful that too many words keep a mother in her higher cortex, I wanted to find a way
to validate her fears and calm her in the same moment. So choosing my words very
carefully I said in a soft warm tone,

"I know you don't want your baby to arrive before your midwife. Know that your body
and your baby clearly know exactly what they are doing. We are here with you."

With that, she seemed to calm slightly and go inward finally joining her baby on the
journey to her. Her baby was clearly moving very fast and mums breath was very quick.
Miindful that she was worried of tearing due to a quick labor, I then said in a calm voice.

"Let’s just slow things down a little by slowing our breath," and I breathed slowly with
her.

With that, she really slowed and became calm and present as her baby began to crown.
But just then, another moment of worry emerged from her,

"Who will catch my baby?" (as she was on all fours and didn't want to move).
"Dad is here ready to catch your baby," I said giving him a big “I’m here to support you
too nod" and showing where his hands needed to be.

He watched his daughter’s head be born and slowly rotate. I sensed a moment of worry
from him that he may not be able to catch his baby so I put my hands down well below
his to show him support and reassure him (although for me I had already made a
mental note to myself that I would do everything possible to not touch her baby as that
is not my role and furthermore wanting to protect the microbiome of this little one).

A moment later their beautiful little girl slid out into her father’s hands and I helped talk
mum through carefully lifting one leg so dad could pass baby under to her. I moved

closer to mum as she sat back and brought her baby up to her chest with the most
beautiful calm, empowered look on her face. I remember thinking with reverence,

“Wow, birth is just so normal." I was so caught up in the moment!

Then, suddenly feeling responsible to some degree, thoughts came to me,
“Check the baby’s color.”
“Check the baby’s breathing.”
“Keep the baby warm.” I quickly turned to my side seeing a clean towel wrapped in a
hottie. What a miracle!

We wrapped their new baby girl promptly in a beautiful warm towel and laid her on her
on mum’s chest. She was born ten minutes after I arrived and half an hour before the
midwife arrived.

The mother has since told me how empowering this birth experience was for her. She
said it could have easily been just as scary as her second unattended birth but simply
having someone with her that was calm and positive really allowed her to step into the
moment and be present with her baby girl as they began their next journey of life
together.

For me, this birth was one of the biggest divine gifts I will ever receive. It showed me
that both my knowledge of birth and my ability to calmly trust my instincts in the
moment, were enough to significantly support and help the mother, father, and baby to
have an empowering birth experience.

Later in the kitchen the father beamed saying to me,

"I can't believe I delivered my daughter!"

As this was my second experience with birth support to date, and a much more close up
one than my first beautiful experience, I did find myself thinking of all that could have
gone wrong later in the day... I have been able to settle on the reassurance for myself
that if anything untoward would have happened we would have worked through that
together in love. The key words that linger for me are “Together with Love.” The birth
was a gift my soul will always remember.

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Virtual Doula-ing During Covid-19 By Amara Minnis, CCE(BWI), CD(DONA)

These are unprecedented times. Have you heard? Of course you have. And you have probably
said that same thing yourself. We are throwing this phrase about so much with the COVID-19
pandemic that it is becoming alarmingly normal to be living in unprecedented times. Everyone
has been impacted by the adjustments that have been made to preserve health and safety. And
right about now, if it hasn’t already, it’s become a struggle. I’ve got to be honest, when I first
learned of the restrictions at our local hospitals, I was angry. I was upset that the women who
had chosen to have doulas at their birth would be forced to decide between having their
partner present or their doula. But when I took some time to reflect on the severity of the
situation, my heart was settled knowing that the restrictions were made for the health and
safety of everyone, including me. So I changed my thinking and jumped on board with my doula
sisters in being creative and inventive during the pandemic.
At the heart of the matter, my work as a doula is the same as it always has been. We have our
prenatal visit and our postpartum visit, only now it occurs virtually using Facetime or Zoom. It’s
important more than ever that we connect and discuss fears and worries about the upcoming
birth. It’s coming together as a team, and an opportunity for me to reassure and encourage
during what is such an uncertain and to some, scary time to have a baby. I am present for my
clients, offering reassurance and nonjudgmental support. And then postpartum, when stay in
place mandates have limited or eliminated the option of postpartum help from family and
friends, it’s critical that I check-in with my clients to see how they are doing and to answer any
questions or give any encouragement I can. It’s easy to feel isolated after giving birth in
ordinary times. In a pandemic, it’s pretty much a guarantee.
While the current situation has made it so I am not physically present in their birth space, I’m
still a presence at their birth. Let me elaborate. Some clients have chosen to have steady
support by way of video, using Facetime or Zoom. We are in touch in early labor same as
always, by phone or text. Then when their labor intensifies to the point that they would
summon me to join them, we setup the video connection and I am there. The words are the
same, the questions are those I would ask in person, and the recommendations are as the
situation warrants (cold cloth, position changes, comfort measures). Sometimes I am quiet,
assessing, watching and listening, ready to help when the need arises. But we know that
women are made to birth and as such staying silent is as important or more so, than speaking.
Some clients have preferred steady connection the whole way through with text and phone
calls and so I have honored that preference too.
I have been so very pleased with the reception I have received as a virtual doula in our area
hospitals as well. The nurses are working so hard to take care of their patients with the added
stress that comes with working in the medical field during a pandemic. And they have
graciously welcomed me to the birth space virtually. They have helped to incorporate me by
moving the laptop when the partner has forgotten, so I have a better view of my client. I have
had conversations with the nurse, midwife, or doctor when there is reason to talk about options and to encourage the birthing woman as a team. We are all still connected, still have the same goal, and still have a job to do.
While the current situation has its challenges, I am grateful to still have the opportunity to
serve my clients. There is more need for doula support more than ever, with such a feeling of
uncertainty day by day, and the fear about bringing new life into a world that feels so unsafe.
As doulas we can still do what we do best—support our clients, offer reassurance and
encouragement, and to be a lifeline when they feel disconnected from the world. Hopefully, we
can return to being a physical presence sooner rather than later. But for now, this will work. We
have a job to do. And our clients are counting on us.

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Oxytocin: The Love Hormone

My name is Ashton Gelzinis, and I am one of the founders of Birth Naturally Brevard, LLC, a childbirth education and doula service business. My partners, Julie O’Neill and Elizabeth McLean, and I have served women in Brevard for several years and love every minute. We are also the owners of a small retail shop called The Oxytocin Emporium where we sell merchandise to support our doula clients and sister birthworkers! We absolutely love the name of our shop because of our fascination with the hormone oxytocin. We hope that our work only raises the levels of oxytocin in the room!

During our time supporting pregnant women and their partners, we have found ourselves fascinated by the process and how women’s bodies evolve and prepare in the weeks leading up to their birth. The hormones of undisturbed labor and the role they play not only during birth, but throughout the mother’s postpartum recovery are nothing but amazing. There are lots of hormones at play during this process, but the one we all hear most often is oxytocin.

Oxytocin. “The Love Hormone.” “The Cuddle Hormone.” This single hormone plays a major role in women’s bodies throughout their lives, but most importantly in pregnancy, birth and postpartum. Oxytocin is produced in the hypothalamus and released by the pituitary gland. Outside of pregnancy and birth, oxytocin contributes to fertility, digestion, wound healing, morality, personal connection, and many other situations throughout our lives.

“Oxytocin is the hormone of love. We share it when we have a good conversation, we share it when we make love, and when we hug, and BIRTH is the biggest brightest time of oxytocin sharing.” -Robin Lim

Let’s look at how this incredible hormone contributes to birth – the way it is supposed to. It plays a pivotal role in the birth process, not only to encourage surges, but it provides the mother with space to fall in love and bond with her newborn.

While laboring, the mother’s body releases oxytocin in response to the pressure of the baby on the pelvic floor. This release of oxytocin brings on those amazing powerful surges that help to efface and dilate the cervix, push the baby down into the birth canal, and birth the placenta. Oxytocin is released throughout the pregnancy, but really reves up just before and during birth for these reasons. In certain situations, mothers can encourage a release of oxytocin with nipple stimulation, a quiet, intimate break with her partner, or clitoral stimulation. If a labor is considered “slow to progress,” trying some of these techniques may help encourage that release and speed up the process rather than using synthetic oxytocin that doesn’t work in the same ways in the body.

Once the baby is born, more oxytocin is released, the placenta is delivered and afterbirth contractions continue to help close up the placental site and slow bleeding.

When her baby is born, the mother takes one look at this new life and gets another burst of this amazing hormone to help encourage her to bond and fall in love her new bundle. Oxytocin forces us to slow down and focus on what is most important – nurturing and feeding our baby. Every latch causes another release that helps to slow any postpartum bleeding and encourages her uterus to return to its original size before baby. The oxytocin released during nursing also encourages a healthy milk supply.

Another interesting oxytocin tidbit is that not only birthing mothers release oxytocin. Partners who are involved and present for the birth of their child release higher levels of oxytocin through the end of the pregnancy. Their levels actually continue to stay higher than average for about 6 months after the birth. This hormone in partners who didn’t give birth perform a very similar job – encourages bonding and loving. It truly is the “Love Hormone.”

In any birthing room, let’s do our part to let this hormone work it’s magic. Let’s give women the space they need to birth their babies. Let’s step away from the technological additions to birth and let mothers’ bodies work. When a woman is undisturbed, her body’s hormones work together with her baby to find just the right path for them. As doulas, we hold space, we remind mothers that the oxytocin is working and her body is nothing but incredible. That truly is the honor of my life. Let the oxytocin flow!

 

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Adina’s Testimonial

Attending the BirthWorks childbirth education workshop in Mt Dora, Florida this May was way more than I bargained for! The place was absolutely stunning. A Victorian style historical hotel with sprawling grounds against a backdrop of the magnificent lake and quaint town. But even more than that was the content of this 3 day workshop given by Cathy Daub. The workshop was so comprehensive and included topics such as grieving, mother daughter relationships, optimal pelvic positioning as well as many others that are not usually included in typical childbirth preparation classes. They were all taught through hands on experimental learning and not through didactic teaching. It was the BirthWorks experience I came out with!

One of the really vital things was teaching and facilitating using open ended questions and letting the other party find their inner guide to direct them. That evening I had a chance to really practice this skill. Being a doula, I had a client in labor and sent a backup.  Right before pushing, my backup called me asking if I could speak to the client as she was panicking about pushing. Instead of going into my long speech about why she shouldn’t be scared to push and how she’s done this in the past, I asked her what her fear was. She said she’s afraid she can’t do it. I asked her what she felt she needed to be able to move forward and she said she thought she needed help from the doctor. I said what kind of help. She said she remembered from her last birth that the doctor did supra pubic pressure because the baby’s shoulders got stuck. I gently reminded her that the only reason the doctor did that was to help the shoulders but the head was out already. So she said, “oh ok, but I’m still scared.”  So I asked her, “What do u want?”  She said she wanted her baby to come out without pushing. I said great. Imagine it. She said she can’t because she  has no energy. So at that point I told her to visualize G-ds energy as she inhales coming into her uterus and as she exhales pushing out her baby. She said,”Ok you visualize it for me!”   I said sure and she hung up empowered and pushed her 9 and half pound baby out with one push!!!

It was such a great lesson for me and I can’t thank Cathy and BirthWorks enough!

Earlier that day this same client was laboring pretty slow so I instructed my backup to do the rocking technique we had just learned that morning and she progressed very quickly to 10 cm!

Recently I had a prenatal meeting for a client who had 2 previous c sections and I used the grieving process we learned, asking her if she wanted to share anything that was hurting her  and she ended up telling me about a few childhood moves her family made when she was in school and how she was afraid to get too close to anyone and then have to move again and she came up with the idea that she was scared to carry something through to the end, the finish line. Explaining to her how we birth the way we live, both her previous births she stalled at 3 cm and wasn’t able to progress further. That awareness was amazing for her and it’s all due to the skills I learned in the grieving session.

Thanks a lot!

Adina Hoffman

 

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Janell’s Reflections

Intimate, Connecting and Peaceful, these are the words that come to mind when I reflect back on the 2019 BirthWorks Conference in Mt. Dora, Florida.  The speakers were inspiring and loving as they shared their knowledge and extensive experience with conference attendees.  The location was nostalgic and charming, worth the visit as well.

I personally was in awe of listening to Amber Price and the work she is doing to pave the way for better maternity care.  She shared many thought provoking facts that were spoken in truth and hope as she continues the momentum of a better and healthier maternity system.  She cares so deeply about her passion for improved maternity care and her professionalism in her administrative role is above and beyond “industry standards”.  I truly appreciated the information she shared regarding things that a hospital has control over in relation to addressing a concern or issue with a specific physician having privileges at a specific hospital.  Amber is like the first baby coming through the womb to pave the way for next generations to continue trusting the process of the journey of healthier and less interventions for better birth outcomes for all birthing families.

Another incredible session included Lori Barklage on Trauma Healing.  She emphasized how important it is to understand and to have tools to share with others that have experienced trauma in their childbirth journey.  She shared her heartbreaking stories of her past birth traumas and how she was able to heal those traumas and take those healing journey steps forward and help many others experiencing trauma in birth and other aspects of their lives.  The tool she provided in the workshop was so simple and easy to apply that I will be able to share and utilize its simplicity during the BirthWorks grieving and healing portion of the classes.  She is taking great strides in restoring the healing from trauma and does it in such a caring and loving way.

There were so many great guest speakers and keynote speakers that I just simply could not do them justice on a simple forum as this.  Having Nils Bergman, Michel Odent along with other local experienced and knowledgeable birth-field experts is always a unique quality that BirthWorks offers during the conferences. I highly recommend and encourage anyone thinking about attending a birth conference that is small, but mighty, to give thought to attending next year’s BirthWorks conference in southern California.

 

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Ultrasounds – Risks, Benefits, and Ethical Considerations

Submitted by Sally Dear-Healey, PhD, PPNE, CCE(BWI), Doula(BWI)

Years ago, X-ray was the diagnostic procedure of choice in pregnancy but today we understand more about the harmful effects of radiation so ultrasound is used as a safer alternative.  What we do know today is that every medical procedure has inherent risks known and unknown.  Therefore it is not wise to perform any procedure except if the known risks are higher than the risks of not doing anything.  However, instead of progressing cautiously and limiting exposure, more and more doctors/OB practices order repeated ultrasound scans for most of their patients/clients.

Ultrasounds are a form of electronic fetal monitoring that have become a normalized part of mainstream obstetric practice.  In fact, practically every pregnant woman in the U. S. will have at least one ultrasound scan during her pregnancy and most will have electronic fetal monitoring during their labor and delivery.  These women tend to be influenced by popular magazines, social media,  internet medical media, mainstream pregnancy books, news articles, and oftentimes friends and family members that purport that ultrasounds are necessary to ensure the safety and healthy development and birth of their baby. This article reviews a sampling of the issues, concerns, and benefits related to ultrasounds.

There are multiple issues and problems associated with the routine use of ultrasounds in pregnancy:

  • Most women today don’t question the procedure or educate themselves on its risks and benefits. Even if they have, few feel they have the right or ability to refuse the test(s).
  • Doctors may not have the time or knowledge to educate their patients about the risks and benefits of the procedure.  However, all women have a right to informed consent and should be encouraged to ask any questions they may have.
  • The number of scans is an issue. Instead of one ultrasound, many women have multiple ultrasounds over the course of their pregnancy in addition to “routine” scanning during labor and delivery (Electronic Fetal Monitoring and Dopplers are forms of ultrasound).
  • The integrity of the scanning machine, the length of the scan time, as well as interpretations of the results can be problematic.
  • “Gender reveal” parties based on the result of these scans are becoming more common and some parents have even purchased their own ultrasound machines so they can track the development of their unborn baby.
  • The financial cost of these scans is a significant concern for individuals and for the health care industry overall.  The average cost of an ultrasound in the U.S. is $250 – $300 without insurance.

Thirty years ago, there were concerns about ultrasound based on animal research, as in 1984, Doris Haire’s article in the Journal of Nurse-Midwifery titled “Fetal effects of ultrasound: A growing controversy,” which cited Dr. Melvin E. Stratmeyer, of the Center for Devices and Radiologic Health (CDRH), as saying “Increasing concern has arisen regarding the fetal safety of widely used diagnostic ultrasound in obstetrics,”  but to this day concerns about such things as neuromuscular development, anomalies, and genetic alterations have not been substantiated on animals or humans. In 1985, ACOG (The American College of Obstetrics and Gynecology) issued a technical bulletin that stated, “No well-controlled study has yet proved that routine scanning of all prenatal patients will improve the outcome of pregnancy.”

As a long-time birth worker, and having taught classes in human development and child and family studies for over two decades, I share their collective concerns and argue that, even though it has been thirty-five years since Haire’s article came out, we have yet to fully understand or appreciate the long-term impacts of prenatal ultrasound exposure.  Yet, there is research out that can be drawn upon to make an educated decision.

Nyborg (1987) writes, “Alterations to cell membrane structure have been reported by a number of investigators.  Some alterations include increased density of microvilli and ruffles in cell membrane following exposure that may alter growth characteristics” and “The persistence of a hereditable disturbances in cell motility after ultrasound exposure is especially important and investigations need to be conducted to determine if these effects occur in vitro” (256).

Sarah Buckley, MD, is also very clear about ultrasounds, stating that “Although ultrasound may sometimes be useful when specific problems are suspected, my conclusion is that it is at best ineffective and at worse dangerous when used as a ‘screening tool’ for every pregnant woman and her baby. […] Treating the baby as a separate being, ultrasound artificially splits mother from baby well before this is a physiological or psychic reality.  This further…sets the scene for possible but to my mind artificial conflicts of interest between mother and baby in pregnancy birth and parenting” (as quoted in West, 2015).

In 2000, Professor Ruo Feng, of the Institute of Acoustics, Nanjing University, who holds a PhD in physics and has published over 186 scientific papers summarized human studies of prenatal ultrasound and suggested five points of protection.  They are:

  • Ulltrasound should only be used for specific medical indications.
  • Ultrasound, if used, should strictly adhere to the smallest dose principle, that is, the ultrasonic dose should be limited to that which achieves the necessary diagnostic information under the principle of using intensity as small as possible and the irradiation time as short as possible.
  • Commercial or educational fetal ultrasound imaging should be strictly eliminated and ultrasound for the identification of fetal sex and fetal entertainment imaging should be strictly eliminated.
  • Avoid ultrasound in the first trimester of pregnancy. If unavoidable, minimize ultrasound.  Even later, during the 2nd or 3rd trimester, limit ultrasound to 3-5 minutes for sensitive areas, e.g. fetal brain, eyes, spinal cord, heart and other parts,
  • For every physician engaged in clinical ultrasound training, their training should include information on the biological effects of ultrasound and ultrasound diagnostic dose safety knowledge (West, 2015).

In terms of benefits, diagnostic ultrasound may be useful where there is a true medical need, although it is reasonable to conclude from the evidence that many of these conditions auto-correct themselves prior to the birth.  It could also be argued that for the mother who has experienced baby loss, either during a pregnancy or shortly after birth, seeing and hearing her unborn child may help to alleviate stress and anxiety in a subsequent pregnancy, which could also positively influence the well- being of the baby due to decreased cortisol levels.  On the other hand, scanning too much can actually create stress.  Jeffrey Ecker, M.D., chief of the department of obstetrics and gynecology at Massachusetts General Hospital, notes that “It’s important to have a specific question you are trying to address.  If by chance someone thinks they see something off, it can cause unnecessary worry” (Miller, 2016).  According to an article in the Journal of Ultrasound Medicine (2012), Miller et al. report that “Safety information can be scattered, confusing, or subject to commercial conflicts of interest.”

While some of the research presented is dated, it is widely acknowledged that very little has changed, and we still don’t have definitive answers.  If you do decide to have a prenatal ultrasound, it is wise to do the following:

  • Limit the number of scans
  • Have the procedure done by an operator with a high level of skill and competence
  • Have the shortest scan possible.
  • Be clear about what questions you have and be sure to ask them.
  • Most important, remember that it’s your baby and your choice.

 

References

  • American College of Obstetricians and Gynecologists (ACOG). (1985). Diagnostic Ultrasound in Obstetrics and Gynecology.  Technical Bulletin No. 63; October.
  • Haire, D. (1984). Fetal effects of ultrasound: A growing controversy. Journal of Nurse-Midwifery; Vol. 29, No. 4.
  • Mendelsohn, R. Dr. Robert Mendelsohn on Pregnancy and the Dangers of Ultrasound. https://www.youtube.com/watch?time_continue=208&v=YfaUQCp6L1s
  • Miller, D., Smith, N., Baily, M. Czarnota, G., Hynynen, K, Makin, I. (2012). Overview of therapeutic ultrasound applications and safety considerations. Journal of Ultrasound Medicine: 31(4):623-34.
  • Miller, K. (2016). This is How Many Ultrasounds You Actually Need During Pregnancy. Self.com https://www.self.com/story/this-is-how-many-ultrasounds-you-actually-need-during-pregnancy
  • Nyborg, W. L. (1987). Research Priorities in Ultrasound.  In: Repacholi, M.H.. Grandolfo, M., Rindi, A. (Eds.). Ultrasound. Springer: Boston.
  • West, J. (2015).  “50 Human Studies in Utero, Conducted in Modern China Indicate Extreme Risk for Prenatal Ultrasound A New Bibliography.”  Harvoa.org